The proposed project will demonstrate and evaluate an intervention to improve the uptake and use of personal health records (PHRs) in an ambulatory setting. Adoption rates have generally been low, even among patients with chronic conditions such as diabetes although patients with chronic diseases may stand to benefit the most from using a PHR. Critical gaps exist in the literature on the adoption and use of PHRs around the factors that influence patients to adopt or reject a PHR at the time of adoption. Although studies are now emerging on the use of PHRs by patients, we need to better understand the role of PHRs in providing patient-centered care and its impacts for quality and coordination of care. Yet another gap is the lack of knowledge about organizational-level processes and factors influencing PHR adoption and implementation. The specific aims of the proposed project are as follows: (1) Introduce an intervention deploying multiple strategies to improve the uptake and use of PHR in an ambulatory setting;(2) Evaluate the intervention with respect to individual- and organizational-level facilitators and barriers associated with PHR implementation;(3) Assess the impact of the intervention on adoption and use rates;and (4) Analyze the role of the PHR in providing patient-centered care and its impacts on quality and coordination of care. PUBLIC HEALTH RELEVANCE: Personal health records (PHRs) are tools that make it easier for patients to manage their health and to communicate with their doctors and doctor's offices via the Internet. Patients can manage their conditions, by tracking how they are doing, and PHRs also allow them to check their lab results, order prescription refills, and ask questions online. This could result in potential savings in time, effort, and cost for the patient as well as improve their quality of care. Despite this, to date PHR adoption rates among patients have been low, especially among patients with chronic conditions who might benefit most. This project seeks to improve these adoption rates by introducing an intervention with multiple strategies aimed at both patients and the staff at doctor's offices. In addition to the intervention, the project will evaluate why patients adopt or do not adopt a PHR, how patients use a PHR, and the impact of PHR use on quality of care.